Shahid, I’ve been following your blog for a few months. I was wondering if you know of a HL7 primer for beginners (non-technologists)?

I figured others would want an answer to this question, so I decided to reply publicly. A very good “starter kit” for HL7 are Neotool’s Whitepapers like Why Do I Need an HL7 Interface Engine?. Definitely register for their free HL7 Reference Guide, too. When you’re ready to dive in deeper, check out their “Fast15″ set of webinars that give quick guidance on various integration subjects.

Israel Lagares wrote me recently about the beta launch of his new site www.healthranker.com, which is a social media news/voting site dedicated to health and wellness. He said he created it because he got tired of the larger social media sites not giving enough love to the healthcare sector. Good work, Israel — we could use more sites like these.

The health IT industry has been working on personal health records (PHRs) for a while and I suspect it will take years before they really take off in a big way. PHRs are likely not to become prevalent at least until the ambulatory care market starts to recognize their utility and doctors convince patients to use them.

I just ran across this new device: MiCard. MiCARD is the size of a credit card (just a bit thicker) and you load your medical record onto it. Once you’ve got it loaded, the following information is basically carried around in your hip pocket or purse:

Those of us pursuing open source in healthcare IT always like to keep our eyes on what’s going at Medsphere and WorldVistA. It was great to see this interview with the new CEO of Medsphere.

These were my favorite questions:

LMN: It has been said that: “Medsphere could have been the “RedHat of Medical IT” that our community desperately needs. Instead they are the “Enron of Medical IT”.” because of the lawsuit against its founders Scott and Steve Shreeve. What are your thoughts on that?

MD: I can???t really comment on the lawsuit because it is an ongoing lawsuit. I???m not part of it and I will not be part of it. I hope that it gets settled soon. That???s the intent, or I hope that is the intent of all involved. I don???t know what you mean by Enron. I absolutely believe that this company has the ability to be the Redhat of Health IT.

LMN: Medsphere can play the Free/Open Source software card, reaping the goodwill of Free/Open Source while locking in customers by partially using proprietary products. What is your stance on this? Under your control will Medsphere be a ‘pure’ Free/Open Source company or a hybrid Free/Open Source and proprietary software company?

MD: It???s too early. I???ve been on the job for a week so it is too early to definitively answer that question. Most companies run a hybrid model. That???s something we are looking at. I have to spend some time researching this.

So, basically, he dodged the most important questions that have been keeping people from really embracing Medsphere. Lets hope Michael gets Medsphere back on track soon. There’s so much promise there.

I’m a huge fan of thin-client systems but the thinner the client, the less functionality it seems to support. A pretty smart colleague of mine, Fran??ois Jean, is an engineer at Cardinal Health working on a bed side information system and he has some suggestions for healthcare IT systems that need to stay thin for deployment but remain just as functional as a desktop app. Fran??ois has more than 10 years of experience in the computer science field and is interested in simplifying and improving the quality of software for a faster time to market while maintaining a stellar customer experience. He’s in Cardinal’s Operational Excellence program where he’s training to become a Lean/Six-Sigma Green Belt. Fran??ois has a master’s in Artificial Intelligence, a baccalaureate in philosophy and another one in computer science/mathematics. All that means he’s very well qualified and you should take his advice. . He writes:

Shahid, your article about SaaS was very interesting. I???m a big fan of web based applications for the following reasons: available from almost everywhere, do not necessitate any installation on the client side, are always up to date and the client does not have to worry about backup or hardware maintenance. However, your article highlights two very important issues related to these types of applications: availability and privacy. Both of them are VERY important in healthcare and we should address them in every implementation of SaaS.

A very good but often undervalued option for SaaS applications is the RIA (Rich Internet application) model. RIA can be used to bridge the gap between the rich API interface provided by the SaaS application and desktop-style user experience. RIA are basically web applications that have the features and functionality of traditional desktop applications. In other words, you experience the feeling of a desktop application in a web based application. Freely available examples of this include Google mail, New Yahoo! Mail, Google docs, Google Maps, etc.

Different frameworks are available to develop these applications; currently at my company we are exploring OpenLaszlo. We’ve use it to create Flash applications but it can also be used to create ???lighter??? applications (DHTML) for less powerful devices. OpenLaszlo can seamlessly generate applications supporting a wide array of browsers (including the safari browser on the iPhone!).

In our case, we wanted to replace a very simple JSP based application with a more RIA based solution to improve the user experience, we wanted the ability to refresh the content of a page without reloading it, have drag and drop functionality, have a fast response time on the client and more important to be free from any HTML and JavaScript limitation.

Since our OpenLaszlo application was able to talk to our backend using standard SOAP Web Service calls; no effort was lost in updating our backend. There is a learning curve before becoming efficient with the OpenLaszlo framework but the productivity gain from this framework rewarded the effort we put into.

Our application succeeds in delivering a desktop like experience to the user. In fact, once the application is running in full screen, you cannot tell it???s a Web application. There are many advantages:

No need to install anything on the client;

The client has always the most recent version of the application;

Very light weight (compare to a Java applet);

Fast and no flickering while updating the content of a page (unlike many web based application).

Run everywhere in almost every browser;

Some disadvantages:

A network problem could stop everyone (but desktop application tends to depend more and more on networks);

Data are stored remotely, privacy issue must be addressed;

Requires a solid backend infrastructure to prevent any downtime;

In our case, we could also have used the Adobe Flex framework to develop our Flash application. We choose OpenLaszlo mainly because it enables us to deliver our application on a variety of platforms (I must admit that we only deliver our application under Flash).

You would like to add multimedia, video conference or voice chat to your RIA? OpenLaszlo support it through the ???red5??? open source Flash Server. We had no use for it in our application, but we did some tests and were able to have a video chat application running in our browser in less than one day.

I personally believe in RIA for healthcare applications and our experience shows us that we can create a web application with a very good user experience. The user experience in health care is very important; we must be able to give the best feedback possible to the user and let him do his task the most naturally possible. The interface should never be an obstacle between the healthcare personnel and the reality they try to describe/comprehend through the interface they have between them and the data.

As a health IT blogger I’m often asked about books and articles that can introduce the general topic of technology (and IT) in healthcare. One of the nicest free resources is available at NIH. It’s called HTA 101: Introduction Health Technology Assessment. It’s worth reading much of the document but there’s a section on fundamental concepts and issues that’s really useful. It’s not specific to IT and the document is more about assessing technology than using it but it’s a good introductory document. Of special interest is the nice glossary.

I’ve started this posting merely as a repository — if you know of any introductory materials that could help your fellow colleagues or those new to health IT, please post a comment here.

As all you probably already know, I’m a follower of healthcare startups and am a sucker for new ideas and smart people. I was recently introduced to Joshua Rosenthal, Ph.D. and when I found out he’s a Fulbright recipient whose work focuses on behavior change I knew I had to get him to share his thoughts about how IT can help. He recently worked with a small team creating clinical facts systems and data architectures for a disease management company with about 20 million members and a multi-dimensional database for a large health plan, tying together disparate data sources (service center calls, web sessions, claims, lab, Dartmouth Atlas, census, consumer/commercial marketing data, etc.) at the member level to give a single customer view and segment populations according to attitudinal, motivational and behavioral attributes. In their current start up, Sprigley ( www.Sprigley.com/blog ), they are creating an application that allows a “smart conversation” to entertain people as they become more engaged in their own health and wellness, to find personalized resources and to create a valuable data asset for their lifelong care. Dr. Rosenthal knows this stuff cold — here’s his guest article.

Eat eggs, don???t eat eggs. Drink as much wine as you possibly can??? don???t touch a drop. Take hormone replacement therapy??? avoid it like the plague. Get your childhood vaccinations???avoid them, they???re associated with autism. Oh by the way, be sure to choose the physician with the best outcomes. Don???t forget to comparison shop your health insurance benefits ??? etc. ??? etc. ??? etc.

One of the problems with paternalistic approaches to behavior changeis that the ???parents??? often disagree. People loose confidence in conflicting messages and that is especially damaging when the messaging asks someone to do more and more (here???s a lump sum, go find a high deducible plan). Even if you try and segment by attitudinal, motivational and behavioral attributes, at the end of the day telling people to do something or avoid something doesn???t really work.

Even when people believe that something is beneficial, there is a personal gap (fill in favorite academic term here) that prevents action. I know I should eat better, exercise more, join a DM or health coaching program. Behavior change???s devil, like so many others, is in the details. What type of exercise, what type of nutritional changes, how do I incorporate them into my daily life, and arguably most importantly, will they work for me?

Solution. Ask people what motivates them. You know what motivates you best. You know what works for you best. What you???re likely to do, what you’re not. Then aggregate that data. Create a community with a data backbone ??? give people their own lifelong data asset and the tools to interpret it - aggregate observational data.

Lights flip on. Cameras roll. Oprah is doing her thing. Celebrities and children with autism. Doctors offering theories based on literature from differing schools. Paternalistic overtones galore. Finally one frazzled parent stands up and say, in effect, ???Hey, you guys are not taking us parents seriously and we???re the ones with millions of hours of observational data.??? Show blows up ??? spins off other shows ??? lights up You Tube. Pent up demand to contribute. Jenny wanted to see what other parents with similar children did in her situation, what are the top five things they need to know? Show her and her child compared to their peers when facing decisions and show the outcomes of those decisions and you have her.

Not just her, anyone faced with behavior change. Have back pain? Think about surgery or chiropractic treatment ??? 45% of people ???like you??? chose A and 15% reported success - 55% chose B and 75% had success. Why don???t you shop your data out and see what responses you get? Hey, Joe coach potato ??? the vast majority of people like you who tried this exercise program had really good success, even when they were initially hesitant. That???s gold. Decades old in financial services but revolutionary in health care.

Um, yeah, sounds great. As long as we???re at it why not sundaes that are good for you and never-ending weekends? How, exactly, to we get to this fairy tale? Google, Amazon, Yahoo, Microsoft and their likes creating lifelong data assets for consumers that the consumers control.

Um, but haven???t plans tried that with Personal Health Records and they???ve never worked? Yep, but people hate their plans and don???t trust them ??? why volunteer incriminating information. And they will change jobs and employers every couple of years so they don???t bother.

Okay, but where does the data come from? Physicians groups, one-click requests from individuals to their plans, and self-reported data (speaking from experience, we can create models from self-reported data that rival and even exceed the predicative power from claims-based models) and the web companies will incentive individuals to self-report.

But it can???t be that easy! It???s not. You need a data standard and some serious plumbing that???s accessible via an API. But you already know the web companies are doing that. To find people ???like me??? you need some multidimensional databases that can give a single customer view ??? and that is tough. You also need an integrated fact system to interpret the data and profile individuals clinically, attitudinally, motivationally and behaviorally and that???s years of research. You also need a user-friendly application sitting on top of the web companies API and giving a great consumer experience.

Jenny, here are the top five things people like you and like your child think you need to know. Here is what they???ve chosen, here???s how that???s worked for them. Here???s where to sign up.